Expert: Mary Gordon - 5/16/2011

Question
My father aged 65 has advanced PD. Cannot talk difficult swallowing. in a wheel chair. Today X ray revealed a Patch in one lung. Is it Pneumonia? Whats the course of action? does it mean he's nearing his end? My parents are thinking of moving from their home to my sisiters in another city. Is this a good time to do it? Due to his illness my family is under alot of pressure and pain. I would appreciate your response alot.
Thank you in advance
. ANusha

Answer
Anusha, it's impossible for me to know what the patch in his lung is. These are questions for a doctor who is familiar with your father. Even if it is pneumonia, that doesn't mean this is the end.

People in true end stage dementia generally are too weak and floppy to sit up in a wheel chair. They are usually propped up either in a chair or in bed, or they will slide dow or flop over. They can't hold up their own heads. They sleep all the time. They are incontinent. They have a history of weight loss despite careful hand feeding. They become very frail and move around very little, so they have to be repositioned constantly to prevent bedsores. They are generally unaware of where they are or who they are with, and have no speech, nor do they understand what is said to them.  They have a recent history of repeated infections as their immune systems break down.

Although your father sounds like he is advancing in his illness, it does not sound like he is necessarily at the end. When a person is truly approaching the end, a family may decide they do not want any life saving treatments employed should their loved one's have a crisis. They decide it is not worth putting their loved one through painful, scary or confusing treatments, tests or procedures. Instead, they opt for palliative care, which is aimed at keeping the person happy, comfortable, peaceful and free of pain.  Usually the doctors and the family decide together that it is time to stop trying to cure illness or prolong life, and instead focus on quality of life. It is hard for many people to accept that the person is gradually dying, and that nature will take its course.

If your father can still sit in a chair and has developed pneumonia, antibiotics or other medications may cure him, and make him more comfortable, and that may be worth doing. On the other hands, if it was cancer, you might decide you don't want to put him through challenging treatments or surgery, because it would be too hard on him and might not really result in any benefit.

As to the move, I do think it might be a very good time to move close to other family members. As your father gets worse, your poor mother will need more and more help and support both physically and emotionally. She will be very alone unless there are loved ones close by to help her. It's already going to be a very difficult move because it's been left so late. I understand why your parents want to move.  Right now is as good as it is going to get - and he will get worse with time. Waiting to move until he is worse will not make it any easier.

I'm thinking of you and your family. I know this is very painful and upsetting, and you wish you could do something to change the situation. All you can do is love your father and mother and try to help them as much as you can.

Mary